Lightner Amy L, Moncrief Sara B, Smyrk Thomas C, Pemberton John H, Haddock Michael G, Larson David W, Dozois Eric J, Mathis Kellie L
Division of Colon and Rectal Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Division of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA.
Int J Colorectal Dis. 2017 May;32(5):661-666. doi: 10.1007/s00384-017-2794-8. Epub 2017 Mar 14.
Anal squamous cell carcinoma (ASCC) is rare, accounting for only 1% of gastrointestinal malignancies. We sought to better understand management strategies for ASCC in the setting of Crohn's disease (CD).
A retrospective chart review from 2001 to 2016 was conducted using ICD-9/10 codes for CD (555.9/K50) and ASCC (154.3/C44.520). Adult patients with a diagnosis of CD at the time of ASCC diagnosis were included.
Seven patients (five female) were included with a median age of 50 years. The majority presented with perianal pain (three) and bleeding (four). Mean duration of CD was 20 years. Five patients had active perianal fistulizing disease at the time of ASCC diagnosis. Clinical stage at diagnosis of ASCC was stage 0 (n = 1), stage I (n = 1), stage II (n = 1), stage III (n = 2), stage IV (n = 1), and unknown (n = 1). All patients were treated with radiation and chemotherapy. Three patients experienced complications during radiation therapy: fistulizing disease, stenotic disease, and flap necrosis. Two patients had persistent disease at 6 months; one patient underwent abdominoperineal resection (APR) and the other chemotherapy and radiation. Two patients developed locally residual and metastatic disease and died within 1 year of diagnosis. Five-year disease-free survival was 56%.
While the standard Nigro protocol remains standard of care in patients with ASCC, in the setting of CD, patients may be best approached as a case-by-case basis and may even require an operation first due to complications from radiation and aggressive nature of disease. Due to poor treatment outcomes, surveillance guidelines for this patient population are necessary.
肛管鳞状细胞癌（ASCC）较为罕见，仅占胃肠道恶性肿瘤的1%。我们试图更好地了解克罗恩病（CD）背景下ASCC的管理策略。
使用国际疾病分类第九版/第十版（ICD - 9/10）编码对2001年至2016年的病历进行回顾性分析，其中CD编码为555.9/K50，ASCC编码为154.3/C44.520。纳入在ASCC诊断时已确诊为CD的成年患者。
共纳入7例患者（5例女性），中位年龄为50岁。多数患者表现为肛周疼痛（3例）和出血（4例）。CD的平均病程为20年。5例患者在ASCC诊断时患有活动性肛周瘘管病。ASCC诊断时的临床分期为0期（n = 1）、I期（n = 1）、II期（n = 1）、III期（n = 2）、IV期（n = 1），分期不明（n = 1）。所有患者均接受了放疗和化疗。3例患者在放疗期间出现并发症：瘘管病、狭窄性疾病和皮瓣坏死。2例患者在6个月时疾病持续存在；1例患者接受了腹会阴联合切除术（APR），另1例接受了化疗和放疗。2例患者出现局部残留和转移性疾病，并在诊断后1年内死亡。5年无病生存率为56%。
虽然标准的Nigro方案仍是ASCC患者的标准治疗方法，但在CD背景下，患者可能最好逐案处理，甚至可能因放疗并发症和疾病的侵袭性而首先需要进行手术。由于治疗效果不佳，有必要为这一患者群体制定监测指南。
